1437469145 NPI number — LAUREN BROOKE SHINNICK OT

Table of content: LAUREN BROOKE SHINNICK OT (NPI 1437469145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437469145 NPI number — LAUREN BROOKE SHINNICK OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHINNICK
Provider First Name:
LAUREN
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437469145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 SULLIVAN TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-7958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-991-2034
Provider Business Mailing Address Fax Number:
610-438-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 TRAVELERS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29485-8287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-832-8481
Provider Business Practice Location Address Fax Number:
843-832-8621
Provider Enumeration Date:
10/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  3439 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)